Epicardial adipose tissue thickness can be used to predict major adverse cardiac events Asli Tanindi, Aycan F. Erkan and Berkay Ekici Objective Increase in epicardial adipose tissue (EAT) thickness is associated with subclinical and manifest coronary artery disease. In addition, it is associated with the severity and extent of coronary atherosclerosis. We aimed to investigate whether increased EAT thickness is associated with adverse cardiovascular outcomes. Patients and methods Two hundred consecutive patients who were admitted with stable angina pectoris, unstable angina pectoris or acute myocardial infarction (MI), and had undergone coronary angiography were included and followed for revascularization, nonfatal MI, hospitalization for heart failure and cardiovascular death for 26 (5–30) months. Results There were significantly more revascularizations, nonfatal MI and cardiovascular death in patients with an initial EAT thickness more than 7 mm (P < 0.001 for all). Significant predictors of cardiovascular death were identified as an EAT thickness more than 7 mm [hazard ratio (HR) 1.9, 95% confidence interval (CI) 0.4–8.3, P = 0.039] and diabetes (HR 3.42, 95% CI 0.7–17.5, P = 0.014) in the multivariate Cox regression analysis. Event-free survival for cardiovascular death in the EAT up to 7 mm group was 97.9%, whereas it was 90.7% in the EAT more than 7mm group (P = 0.021). In addition, significant predictors of MI were identified as an EAT thickness more than 7 mm (HR 2.4, 95% CI 0.6–10.0, P = 0.021) and diabetes (HR 3.4, 95% CI 1.0–11.2, P = 0.04). Event-free survival for MI in the EAT up to 7 mm group was 96.4%, whereas it was 68.2% in the EAT more than 7 mm group (P = 0.001). Conclusion Increase in EAT thickness independently predicts adverse cardiac events including MI and cardiovascular death. Coron Artery Dis 26:686–691 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Coronary Artery Disease 2015, 26:686–691 Keywords: cardiovascular death, coronary revascularization, epicardial adipose tissue thickness, major adverse cardiac event, myocardial infarction Department of Cardiology, Faculty of Medicine, Ufuk University, Ankara, Turkey Correspondence to Asli Tanindi, MD, Department of Cardiology, Dr. Rıdvan Ege Hospital, Faculty of Medicine, Ufuk University, Mevlana Bulvarı No. 86-88, Balgat, Ankara 06520, Turkey Tel: + 90 312 204 4082; fax: + 90 312 204 4055; e-mail: aslitanindi@gmail.com Received 22 April 2015 Revised 17 June 2015 Accepted 16 July 2015 Introduction Epicardial adipose tissue (EAT) is a specialized visceral adi- pose tissue (VAT) between visceral pericardium and myo- cardium [1], and it has been linked to coronary artery disease (CAD) risk factors, subclinical atherosclerosis and manifest CAD [2–5]. Many studies showed that EAT was associated with the extent and severity of CAD [6,7]. EAT has also been related to the presence of more vulnerable atherosclerotic plaques, detected using intravascular ultrasound [8]. We have recently shown that increased EAT thickness is associated with impaired epicardial and myocardial perfusion [9]. The proposed mechanism of the interaction between coronary atherosclerosis and EAT is that EAT secretes many proa- therogenic and proinflammatory hormones and cytokines, which may induce initiation and progression of CAD by endocrine and paracrine mechanisms [10]. Although there are considerable data on the relation between coronary atherosclerosis and EAT, there is limited information on whether these associations trans- late into hard clinical end points and major adverse car- diac events (MACEs). We aimed to search prospectively whether EAT thickness assessed using transthoracic echocardiography has an independent effect on clinical outcomes such as cardiovascular death, nonfatal myo- cardial infarction (MI), hospitalization for heart failure and coronary revascularization in patients with CAD in the long term. We hypothesize that increased EAT thickness is associated with an increase in MACEs including coronary revascularization, MI and cardiovas- cular death, and might be used as a risk predictor. Patients and methods We consecutively enrolled 200 eligible patients with the clinical diagnosis of CAD who were admitted to our hospital with stable angina pectoris or acute coronary syndrome (ST- elevation myocardial infarction, non-ST-elevation myocardial infarction, unstable angina pectoris) between June 2012 and October 2012 and those who were decided to undergo cor- onary angiography and followed for cardiovascular outcomes after the index hospitalization. Exclusion criteria were a history of either surgical or percutaneous previous revascu- larization, pericardial effusion, more than moderate valvular pathology, poor echocardiographic imaging and patients who were lost to follow-up. Anthropometric parameters, previous medical history, presence of atherosclerosis risk factors and medications were recorded for each patient. 686 Original research 0954-6928 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCA.0000000000000296 Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.